SA Patients Research Articles

The incidence of meniscal cyst formation following meniscal repair using the all-inside suture anchor device is comparable to conventional techniques.

Post-operative meniscal cyst formation occurs following all-inside device meniscal repair. This study aimed to compare the incidence of cysts in patients who underwent meniscal repair with and without all-inside suture devices. This retrospective study included 227 knees that underwent meniscal repair between 2021 and 2022. The incidence of post-operative meniscal cysts was compared between patients who underwent repair using an all-inside suture anchor device (Group SA) and those who did not use an anchor (Group NA), based on post-operative magnetic resonance imaging (MRI) findings. Risk factors, such as the number of anchors used, were investigated. Using a subgroup analysis, the incidence of meniscal cysts based on the type of device used was investigated. Groups SA and NA comprised 125 and 102 knees, respectively. Group SA had 11 cases of cysts (9% incidence), whereas Group NA had 7 cases (7% incidence), and no statistically significant difference was observed (p = 0.63). Symptomatic cysts were observed in two patients (1.6%) in Group SA, whereas none was observed in Group NA (0%); the difference was not significant (p = 0.50). Factors such as the number of anchors and sutures used and MRI timing were not identified as risk factors. Cyst incidence varied according to anchor type: Stryker AIR+ (4 out of 55, 7%), Smith & Nephew Fast-Fix 360 (7 out of 56, 13%) and Arthrex Fiber Stitch (0 out of 26, 0%), with no significant difference found (p = 0.14). The incidence of cysts in patients undergoing meniscal repair with an all-inside suture anchor device was 9%, showing no significant difference compared with Group NA. Cyst incidence was not affected by device type. Level III, retrospective comparative study.

Determining the accuracy of the leukocyte esterase reagent strip test in the rapid diagnosis of adult septic arthritis

BackgroundsSeptic arthritis is a dangerous disease that occurs when microorganisms enter synovial fluid. It needs fast and accurate management; otherwise, it can harm the patient’s life. Currently, the tests measure WBC and PMN in SF, so we hypothesized to use a proxy that is easier and faster to measure. Leukocyte esterase is an enzyme secreted by neutrophils that can be found in the synovial fluid of SA patients. In this study, we tried to investigate the sensitivity and specificity of leukocyte esterase in diagnosing septic arthritis.MethodsWe obtained synovial fluid samples from forty-six patients suspected of having septic arthritis and fifty-eight healthy individuals and measured the WBCs, ESR, CRP, PMN, glucose, and protein of SF in 2021. We also used the leukocyte esterase dipstick test to investigate the level of LE in synovial fluid for one minute.ResultsBased on clinical and paraclinical criteria, sixteen out of the forty-six patients were diagnosed with SA. When (++) was considered positive, the sensitivity and specificity of the LE dipstick test for the diagnosis of SA were 93.7% (95% CI: 81.8–100%) and 60% (95% CI: 42.4–77.5%, P = 0.000), respectively. When both (+) and (++) were considered positive, they were 100% and 43.3% (95% CI: 25.6–61.0% P = 0.000), respectively. All the patients in the control group had negative cultures and LE test readings (specificity = 100%).ConclusionThe LE dipstick test can be a valuable diagnostic tool in the initial diagnosis of SA since it is affordable, fast, and reliable.

Dupilumab responder types and predicting factors in patients with type 2 severe asthma: A real-world cohort study

BackgroundSevere asthma (SA) presents a considerable healthcare challenge despite optimal standard treatment. Dupilumab, which is effective in type 2 (T2) SA patients, demonstrates variable responses, categorizing patients as non-responders, partial responders, or those achieving clinical remission. However, real-world response rates remain underexplored. Additionally, understanding the characteristics of patients achieving clinical remission is crucial for predicting favourable responses to dupilumab. ObjectiveTo investigate responder types and identify predictors of clinical remission and non-response induced by dupilumab in a real-world cohort of SA patients. MethodsWe analyzed retrospective data from SA patients undergoing dupilumab treatment in a study conducted at Franciscus Gasthuis & Vlietland hospital. Data were collected at baseline and at a 12 to 24-months follow-up (T = 12). Response rates were evaluated at T = 12. Predictors of non-response and clinical remission were investigated using multivariate logistic regression analysis with a stepwise forward variable selection approach. ResultsAmong the 175 patients screened, 136 met the inclusion criteria. At T = 12, 31.6 % achieved clinical remission, 47.1 % were partial responders and 21.3 % were non-responders. Predictors associated with clinical remission included high baseline blood eosinophil counts (BEC) and male sex. Conversely, younger age at baseline, low baseline total immunoglobin E (IgE) and low baseline fractional exhaled nitric oxide (FeNO) levels were identified as predictors of non-response. ConclusionsDupilumab results in clinical disease remission in one-third of the treated patients. Clinical remission is predicted by high BEC and male sex, whereas low total IgE, low FeNO and younger age indicate a lower likelihood of response.

Childhood severe asthma: relationship among asthma control scores, FeNO, spirometry and impulse oscillometry

IntroductionThe evaluation of the asthmatic patient is usually based on clinical and functional parameters that do not necessarily evidence the degree of airway inflammation. The aim of this study was to analyze whether clinical scores (CS) correlate with spirometry (S), impulse oscillometry (IO) and FeNO, in severe asthmatic children.Material and methodsA multicentric, prospective, cross-sectional study was conducted over a 12-month period. All SA patients (6–18 years old) followed-up in the Pulmonology Department were recruited. CS, FeNO measurements, IO and S were consecutively performed on the same day. Asthma control was ascertained using ACT and GINAq. A cut-off value of ≥ 25 parts per billion (ppb) was used to define airway inflammation.ResultsEighty-one patients were included. ACT: 75% (n 61) were controlled; GINAq: 44.5% (n 36) were controlled; 39.5% (n 32) were partly controlled, and 16% (n 13) were uncontrolled. FeNO had a median value of 24 ppb (IQR 14–41); FeNO ≥ 25 ppb was observed in 49% of patients (n 39). ROC AUC for FeNO vs. ACT was 0.71 (95%CI 0.57–0.86), PPV 0.47, NPV 0.87, SE 0.61, SP 0.80; FeNO vs. GINAq was ROC AUC 0.69 (95%CI 0.54–0.85), PPV 0.34, NPV 0.91, SE 0.62, SP 0.77; Youden cut-off FeNO > 39 ppb for both CS.ConclusionIn severe asthmatic children, current symptoms control as evidenced by ACT and GINA correlates with low FeNO values. Clinical scores showed good correlation with airway inflammation.

EEG alpha reactivity on eyes opening discriminates patients with schizophrenia and schizoaffective disorder

ObjectiveAlpha activity in the electroencephalogram (EEG) is typically dominant during rest with closed eyes but suppressed by visual stimulation. Previous research has shown that alpha-blockade is less pronounced in schizophrenia patients compared to healthy individuals, but no studies have examined it in schizoaffective disorder. MethodsA resting state EEG was used for the analysis of the alpha-reactivity between the eyes closed and the eyes opened conditions in overall (8 – 13 Hz), low (8 – 10 Hz) and high (10 – 13 Hz) alpha bands in three groups: schizophrenia patients (SC, n = 30), schizoaffective disorder (SA, n = 30), and healthy controls (HC, n = 36). All patients had their first psychotic episode and were receiving antipsychotic therapy. ResultsA significant decrease in alpha power was noted across all subjects from the eyes-closed to eyes-open condition, spanning all regions. Alpha reactivity over the posterior regions was lower in SC compared to HC within overall and high alpha. SA showed a trend towards reduced alpha reactivity compared to HC, especially evident over the left posterior region within the overall alpha. Alpha reactivity was more pronounced over the middle and right posterior regions of SA as compared to SC, particularly in the high alpha. Alpha reactivity in SC and SA patients was associated with various negative symptoms. ConclusionsOur findings imply distinct alterations in arousal mechanisms in SC and SA and their relation to negative symptomatology. Arousal is more preserved in SA. SignificanceThis study is the first to compare the EEG features of arousal in SC and SA.

Evaluation of Hemodynamic Changes and Fluid Response during Anesthesia in Lumbar Disc Hernias with Pleth Variability Index (PVI).

The study aimed to assess the pleth variability index (PVI) in patients undergoing lumbar disc herniation surgery under general and spinal anesthesia, exploring its correlation with fluid responsiveness, position, and hemodynamic parameters. Methods: This prospective study included 88 ASA 1-2 patients, aged 18-65, undergoing 1-3 h elective lumbar disc herniation surgery. Patients in groups GA and SA were observed for demographic, operative, and hemodynamic parameters at specified time points. (3) Results: PVI values were comparable between the GA and SA groups. After 250 mL of fluid loading, both groups showed a significant decrease in basal PVI at T2. Prone positions in GA exhibited higher PI values than in SA. The transition from a prone to supine position maintained PVI, while pulse and MAP decreased.; (4) Conclusions: PVI values were comparable in elective lumbar disc herniation surgery with general and spinal anesthesia. Both groups exhibited significant a PVI decrease at T2 after 250 mL of fluid loading, indicating fluid responsiveness. In general anesthesia, the prone position showed a lower MAP and higher PI values compared to spinal anesthesia. PVI and PI, sensitive to general anesthesia changes, could have beneficial additions to standard hemodynamic monitoring in spinal anesthesia management.

Functional magnetic resonance imaging alternations in suicide attempts individuals and their association with gene expression

BackgroundFunctional Magnetic Resonance Imaging (fMRI) has shown brain activity alterations in individuals with a history of attempted suicide (SA) who are diagnosed with depression disorder (DD) or bipolar disorder (BD). However, patterns of spontaneous brain activity and their genetic correlations need further investigation. MethodsA voxel-based meta-analysis of 19 studies including 26 datasets, involving 742 patients with a history of SA and 978 controls (both nonsuicidal patients and healthy controls) was conducted. We examined fMRI changes in SA patients and analyzed the association between these changes and gene expression profiles using data from the Allen Human Brain Atlas by partial least squares regression analysis. ResultsSA patients demonstrated increased spontaneous brain activity in several brain regions including the bilateral inferior temporal gyrus, hippocampus, fusiform gyrus, and right insula, and decreased activity in areas like the bilateral paracentral lobule and inferior frontal gyrus. Additionally, 5,077 genes were identified, exhibiting expression patterns associated with SA-related fMRI alterations. Functional enrichment analyses demonstrated that these SA-related genes were enriched for biological functions including glutamatergic synapse and mitochondrial structure. Concurrently, specific expression analyses showed that these genes were specifically expressed in the brain tissue, in neurons cells, and during early developmental periods. ConclusionOur findings suggest a neurobiological basis for fMRI abnormalities in SA patients with DD or BD, potentially guiding future genetic and therapeutic research.

Assessment of platelet functional activity in healthy individuals and patients receiving antiplatelet therapy. Possible inconsistencies between aggregation and flow cytometry tests.

Platelet functional activity was assessed in healthy volunteers (HV, n=92), patients with stable angina pectoris (SA, n=42) and acute coronary syndrome (ACS, n=73), treated with acetylsalicylic acid (ASA) + clopidogrel and ASA + ticagrelor, respectively. In all HV and patients we have compared parameters of platelet aggregation (maximum light transmission and velocity, Tmax and Vmax) and parameters, characterizing exposure of platelet activation markers, evaluated by flow cytometry. HV platelets were activated by 10 μM, 1 μM TRAP, and 20 μM, 5 μM, 2.5 μM ADP; patient platelets were activated by 10 μM TRAP and by 20 μM and 5 μM ADP. Strong and significant correlations between the aggregation and flow cytometry parameters (the r correlation coefficient from 0.4 up to >0.6) most frequently were registered in HV platelet during activation by 1 μM TRAP and in SA patients during platelet activation by 20 μM and 5 μM ADP. However, in many other cases these correlations were rather weak (r < 0.3) and sometimes statistically insignificant. In HV the differences in PAC-1 binding parameters between platelets activated by 10 μM TRAP (the strongest agonist) and all ADP concentrations were negligible (≤ 10%), while CD62P binding (at all ADP concentrations) and LTA parameters for (5 μM and 2.5 μM ADP) were significantly lower (by 40-60%). Antiplatelet therapy in patients decreased all parameters as compared to HV, but to varying extents. For 10 μM TRAP the MFI index for PAC-1 binding (40-50% decrease) and for both ADP concentrations the Tmax values (60-85% decrease) appeared to be the most sensitive in comparison with the other parameters that decreased to a lesser extent. The data obtained indicate a possibility of inconsistency between different LTA and flow cytometry parameters in assessing platelet activity and efficacy of antiplatelet drugs.

Correlation of thecal sac cross sectional area to total volume

BackgroundSpinal anesthesia (SA) has been increasingly utilized in lumbar surgery due to its various advantages over general anesthesia (GA), however failure of the first dose requiring intraoperative conversion to GA occurs in as many as 3.6% of SA patients. Some studies have reported that a larger thecal sac volume may dilute the anesthetic and play a role in first dose failure. Unfortunately, easy determination of thecal sac volume has not been reported in the literature. Thus, we sought to determine whether cross-sectional area obtained from MRI accurately predicts the volume of the thecal sac. MethodsWe conducted a retrospective review of 80 patients who underwent lumbar surgery with spinal anesthesia. T1 and T2-weighted MRI sequences were used to measure thecal sac area at each level between L1-S1. The volume of the thecal sac was calculated using HorosTM. A statistical model was derived relating the area at each level to the thecal sac volume. Of the 80 patients, 20% were reserved and utilized to test the accuracy of the statistical model. ResultsThe area of the thecal sac positively correlated with volume at each lumbar level. The area of the thecal sac at the L4-L5 level most accurately represented total thecal sac volume (R2 = 0.588, RMSE = 2.76). ConclusionCross-sectional area of the L4-L5 spinal level obtained from MRI sequences may be utilized as a proxy for thecal sac volume.

Eosinophils to Basophils Rate, Mean Platelet Volume, and Neutrophils to Lymphocyte Rate for the Diagnosis of Systemic Amyloidosis

Methods: CBC, performed by an automated hematology analyzer, included hemoglobin hematocrit, erythrocytes, MCV, MCH, MCHC, platelets, and white blood cell counts and differentials (neutrophils, lymphocytes, monocytes, eosinophils, and basophils), as well as red blood cell distribution width (RDW) and mean platelet volume (MPV). Other indicators were indirectly calculated (by dividing the numerator by the denominator) based on the values of CBC and included neutrophils to lymphocyte rate (NLR), monocytes to lymphocyte rate (MLR) platelets to leukocyte rate (PLR), leukocytes to eosinophil rate (LER), and leukocytes to basophil rate (LBR). Among them, NLR, MLR, and PLR have been linked to various inflammatory conditions, but their role in SA diagnosis is unknown. CBC values obtained at diagnosis from a set of 128 Vietnamese patients with SA (mean age 43, 67% female) treated at Hanoi Medical University Hospital were compared with those derived from 596 age-matched healthy controls. Results: Among the values directly obtained from CBC, only neutrophil counts and MPV were statistically significant between the two groups, with higher neutrophil counts (4,200 vs. 3,700, p = 0.02) and lower MPV (7.41 vs. 8.35, p = 0.0002) observed in SA patients compared with controls. The analysis of other indicators showed significantly higher NLR (2.3 vs. 1.8, p = 0.04) and EBR (4.42 vs. 5.64; p = 0.03) in SA patients compared with controls. No differences in MLR and PLR were observed between SA patients and controls. In multivariate analysis, a higher NLR (p = 0.05), lower MPV (p = 0.001), and higher EBR (p = 0.02) remained associated with the diagnosis of SA. Conclusions: This study substantiates the relevance of a decreased MPV as well as an increased NLR and EBR in patients with SA. CBC is a rapid and low-cost test, and NLR and EBR are easily calculated; thus, these indexes could help clinicians in the diagnosis of SA.

Treatment Modality Impact on Patient-Reported Quality of Life in Human Papilloma Virus-Associated Oropharyngeal Carcinoma.

To prospectively compare the impact of treatment modality on patient-reported quality of life (QOL) in human papillomavirus-associated oropharynx squamous cell carcinoma (HPV + OPSCC). Prospective cohort study. Academic medical center. One hundred one patients with American Joint Committee on Cancer (AJCC) 8th edition T1-3 N0-2 HPV + OPSCC completed the European Organization for Research and Treatment of Cancer Quality of Life Core questionnaire and Head and Neck Module pretreatment and 3-month and 1-year posttreatment. Mean score changes were compared to published minimal clinically important differences. Patients underwent surgery alone (SA: N = 42, 42%), surgery with adjuvant radiation (S-RT: N = 10, 10%), surgery with adjuvant chemoradiation (S-CRT: N = 8, 8%), definitive radiation (RT: N = 11, 11%), or definitive chemoradiation (CRT: N = 30, 30%). SA, S-[C]RT, and [C]RT patients all reported clinically significant difficulty with sense of taste/smell persisting at 1 year. S-[C]RT and [C]RT patients reported statistically and clinically significant worse salivary dysfunction and problems with social eating at 1 year than SA. S-[C]RT patients reported statistically and clinically significant worse fatigue and head and neck pain compared to [C]RT and SA patients at 3 months, but normalized at 1 year. S-CRT compared to S-RT had statistically and clinically worse physical and role functioning and swallowing difficulties at 3 months but this difference was resolved by 1-year posttreatment. HPV + OPSCC patients after SA report the lowest posttreatment QOL impact, whereas after S-CRT report the highest symptom burden. Careful selection for definitive surgery is important given the possibility of adjuvant CRT. Patients can experience persistent sense taste and smell difficulties at 1 year with all treatment modalities. 3 Laryngoscope, 134:1687-1695, 2024.

Low levels of endogenous anabolic androgenic steroids in females with severe asthma taking corticosteroids.

Patients with severe asthma are dependent upon treatment with high doses of inhaled corticosteroids (ICS) and often also oral corticosteroids (OCS). The extent of endogenous androgenic anabolic steroid (EAAS) suppression in asthma has not previously been described in detail. The objective of the present study was to measure urinary concentrations of EAAS in relation to exogenous corticosteroid exposure. Urine collected at baseline in the U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory Disease outcomes) study of severe adult asthmatics (SA, n=408) was analysed by quantitative mass spectrometry. Data were compared to that of mild-to-moderate asthmatics (MMA, n=70) and healthy subjects (HC, n=98) from the same study. The concentrations of urinary endogenous steroid metabolites were substantially lower in SA than in MMA or HC. These differences were more pronounced in SA patients with detectable urinary OCS metabolites. Their dehydroepiandrosterone sulfate (DHEA-S) concentrations were <5% of those in HC, and cortisol concentrations were below the detection limit in 75% of females and 82% of males. The concentrations of EAAS in OCS-positive patients, as well as patients on high-dose ICS only, were more suppressed in females than males (p<0.05). Low levels of DHEA were associated with features of more severe disease and were more prevalent in females (p<0.05). The association between low EAAS and corticosteroid treatment was replicated in 289 of the SA patients at follow-up after 12-18 months. The pronounced suppression of endogenous anabolic androgens in females might contribute to sex differences regarding the prevalence of severe asthma.

LATERAL APPROACH OF POPLITEAL BLOCK VERSUS UNILATERAL SPINAL ANESTHESIA FOR BELOW KNEE SURGERIES: A COMPARATIVE STUDY

Aims and Objectives: The aims of the study were to compare efficacy and side effects of popliteal block and unilateral spinal anesthesia in patients undergoing below knee surgeries. Methods: This was a comparative study comprising patients undergoing below knee surgeries. Sixty patients were divided into two groups depending on whether surgery was done under unilateral spinal anesthesia (Group SA) or popliteal block (Group PB). The parameters compared between the studied groups included hemodynamic changes, onset of motor block, onset and duration of analgesia, duration of motor block, onset of pain, and amount of rescue analgesia required. Side effects such as bradycardia, hypotension, cardiac arrhythmia, and urinary retention were compared between the two groups. SSPS 22.0 was used for statistical analysis and p&lt;0.05 was taken as statistically significant. Results: There were 14 (46.67%) males and 16 (53.33%) females, whereas, in Group PB, there were 13 (43.33%) males and 17 (56.67%) females. Mean age of patients in Group SA was found to be 42.93±16.79 and 39.57±14.05 in Group PB. The mean age and gender distribution and ASA grades of patients in both the groups were found to be comparable with no statistically significant difference. The mean duration of sensory as well as motor block was found to be significantly less in Group SA as compared to Group PB and the difference was statistically highly significant (p&lt;0.001). Group PB showed a better hemodynamic as well as analgesic profile as compared to Group SA. The analgesic requirement in first 24 h was more in Group SA as compared to Group PB and the difference was statistically highly significant (p&lt;0.001). Adverse effects in both the groups were comparable (p&gt;0.05). Conclusion: Popliteal block provides better analgesia and hemodynamic stability as compared to unilateral spinal anesthesia and, hence, can be considered preferred mode of anesthesia in patients undergoing lower limb surgeries.v

0499 Identifications of symptoms clusters by the Quebec Sleep Questionnaire in sleep apnea patients

Abstract Introduction Sleep apnea (SA) patients may present different symptom clusters. The clinical importance of such clustering is supported by the differences in the incidence of cardiovascular diseases between hypersomnolent and non hypersomnolent patients. The Quebec Sleep Questionnaire (QSQ) has been elaborated 20 years ago that documents quality of life in SA patients by measuring the impact of the disease on five different domains (nocturnal and diurnal symptoms, hypersomnolence, emotions and social interactions). Previous cluster analyses took into account the frequency of typical SA symptoms. Many, but not all symptoms selected in these studies are addressed in the QSQ. The objective of this study is to determine if quality of life clusters can be identified using responses collected from the QSQ in SA patients. Methods A cluster analysis was completed in symptom scores collected from the QSQ+ Epworth scores in147 patients who filled in the questionnaire during its validation (75.5 % males, age: 53 ± 11 y, BMI: 30.4 ± 4.7 Kg.m2, AHI 31.3 ± 14.8 /h). For each item, patients were considered as symptomatic for scores ≤ 4 (the lowest the score the higher the impact) and for ESS &amp;gt; 10. Results Three clusters were identified: patients in cluster 1 (20.4 % of patients) can be identified as minimally symptomatic in each domain. In the cluster 2 (32.6 %), quality of life was mainly impacted by hypersomnolence with disturbed sleep. Patients in cluster 3 (46.9 %) reported important impacts on their quality of life in each domain of the QSQ. Gender, BMI and AHI did not differ between the three clusters. However, patients in cluster 1 were significantly younger than those of cluster 2 (50.5 ± 9.9 and 57.6 ± 11.9 years, respectively, p = 0.01). Conclusion Different clusters of quality of life can be identified by the QSQ in SA patients. These clusters seem to have close similarities with previously reported symptom frequency driven clusters. The relationship between quality of life symptom clusters and long-term clinical outcomes should be explored in a large prospective cohort of sleep apnea patients. Support (if any)

Characteristics and risk of coronary-related events following hospitalisation for chronic coronary disease

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Western Australian Department of Health. Background Chronic coronary heart disease (CCD) is associated with a high healthcare burden and expenditure in Western societies, yet population-level data on CCD are limited. Use of hospitalisation data to investigate CCD epidemiology has not been well explored. Our aim was to describe characteristics of patients hospitalised with CCD and to estimate the long-term risk of coronary outcomes in this cohort. Method We used Western Australian state-wide linked hospitalisation/mortality data to identify all hospitalisations for CCD, comprised stable angina (SA, ICD-10-AM I20.1-I20.9) and chronic ischaemic heart disease (IHD, I25) from 2002 – 2017. Index admissions were defined as the first SA or chronic IHD admission in the study period. 14-years of hospitalisation history data were used to identify prior medical history, including admissions for acute coronary syndromes (ACS) +/- angiography, PCI and CABG. Kaplan-Meier survival analyses were used to estimate risk of readmission for coronary outcomes and procedures using up to 15-years of follow-up from linked morbidity/mortality data. Results There were 32,557 index SA and 29,505 index chronic IHD admissions from 2002-2017. SA index case number declined by -3.9%/year while chronic IHD admissions increased steadily (+5.3%/year, age-adjusted). The mean age was 66 years for SA and chronic IHD index admissions, with women on average 3 years younger than men; median length of stay was 3 days. Women comprised a higher proportion of SA admissions (37.8%) than chronic IHD (26.9%, p&amp;lt;0.0001). SA admissions were more likely to be emergency admissions (45.6% vs 13.4%) and have comorbidities including diabetes, hypertension and stroke. Patients with a chronic IHD admission were more likely to undergo angiography only (65.3% vs 46.7%) or revascularisation (20.6% vs 12.9%) during the index admission. Around 1/3 of SA and chronic IHD patients had a prior ACS admission (n=9964 and 8291 respectively); around half of these prior ACS admissions occurred in the 1-year preceding the index SA and chronic IHD admissions (Figure), with the majority occurring in the 90 days immediately prior to the index admission. Following an index SA or chronic IHD admission, the risk of ACS within the initial year of follow-up was 9.4% in men and 8.6% in women with SA, and 5.6% in chronic IHD men and women. This risk increased to &amp;gt;20% in both groups with 15 years of follow-up. The 15-year risk of CVD mortality was 4.3% in men and 4.2% in women following a chronic IHD admission; similar long-term risks were seen following SA admissions. Conclusion The heterogeneity in clinical profile and outcomes between patients admitted for SA versus chronic IHD requires cautious interpretation of hospitalisation data to inform the epidemiology of CCD. However, while mortality risk is low, the risk of ACS readmission is high, indicating significant ongoing morbidity and healthcare burden of CCD.

A prospective evaluation of neck and shoulder function following treatments of early-stage human papillomavirus-associated oropharynx cancer.

To compare post-treatment neck and shoulder function between human papillomavirus-associated oropharynx squamous cell carcinoma (HPV + OPSCC) treatments. Prospective, repeated-measures study. Tertiary care center. Treatment-naïve patients with American Joint Committee on Cancer eighth edition stage T0-3/N0-2 HPV+OPSCC. Patients completed the Neck Dissection Impairment Index (NDII) pre-treatment and 3-months and 1-year post-treatment. The NDII assesses 10 neck and shoulder functions scored 0-5 (total score 0-100), with higher scores suggesting better function. A total of 106 patients underwent: surgery alone (SA, n = 46, 43%), surgery with adjuvant radiation ± chemotherapy (S + a[C]XRT, n = 18, 17%), or definitive radiation ± chemotherapy (d[C]XRT, n = 42, 40%). cTN classification and pre-treatment NDII scores did not differ between groups. SA patients reported worsened 3-month post-treatment versus pre-treatment self-care (4.6 vs. 5.0), lifting light (4.6 vs. 5.0) and heavy (4.2 vs. 4.8) objects, overhead reach (4.5 vs. 4.9), activity (4.5 vs. 4.9), socialization (4.7 vs. 4.9), recreation (4.6 vs. 4.9), and overall score (86.8 vs. 95.3) (all p < 0.05). One-year post-treatment scores (n = 34) were no different than pre-treatment in all domains. S + a[C]XRT patients reported worsened 3-month versus pre-treatment stiffness (4.0 vs. 4.8), lifting heavy objects (3.8 vs. 4.9), overhead reach (4.2 vs. 4.9), socialization (4.6 vs. 5.0), recreation (4.4 vs. 4.9) and overall score (82.4 vs. 96.0) (all p < 0.05). One-year post-treatment scores (n = 13) were no different than pre-treatment in all domains. d[C]XRT patients reported worsened 3-month versus pre-treatment difficulty lifting heavy objects (4.3 vs. 4.7) and recreation (4.3 vs. 4.7). One-year posttreatment scores (n = 21) were no different than pre-treatment in all domains. HPV + OPSCC patients may experience mild shoulder/neck dysfunction 3 months after treatment that usually resolves by 1 year, independent of treatment modality.

O056 The impact of surgical risk factors on the development of stump appendicitis

Abstract Introduction Stump appendicitis (SA) is a post-operative complication where inflammation occurs in the residual appendix following incomplete excision. Diagnosis is delayed due to the history of appendectomy, leading to a higher risk of complications such as perforation and peritonitis. This study aimed to investigate the incidence of SA and the surgical risk factors contributing to its development. Methods A literature review was conducted using Ovid Medline and Embase to evaluate the literature surrounding SA. A retrospective study was conducted at our centre to investigate the incidence of SA between June 2012 and June 2022. Results Literature review revealed 43/12,989 (0.33%) patients with SA. In the local cohort of 5401 patients who underwent appendectomy or right hemicolectomy for appendicitis, 15 developed SA (0.28%). Laparoscopic appendectomy was identified as a risk factor, with 66.67% of SA patients in Cardiff undergoing laparoscopic surgery for their primary appendicitis. Complicated primary appendicitis was reported in 53.33% of SA patients compared to 19.33% of the wider cohort. An appendicolith was present in 33.33% of SA patients compared to 12.11% of the total cohort. Residual stump length above 1.5cm was also acknowledged as a risk factor with a stump length ≥1.5cm reported in all local SA patients. Conclusion SA is associated with modifiable and non-modifiable risk factors. Care should be taken to identify the appendiceal base clearly at primary operation. Complicated appendicitis and the limitations of laparoscopic appendectomy present challenges in identifying the appendiceal base, thus contributing to the development of SA.

Neural responses to social decision-making in suicide attempters with mental disorders

BackgroundDecision-making deficits have been reported in suicide attempters and may be a neuropsychological trait of vulnerability to suicidal behavior. However, little is known about how neural activity is altered in decision-making. This study aimed to investigate the neural responses in suicide attempters with mental disorders during social decision-making. Electroencephalography (EEG) were recorded from 52 patients with mental disorders with past suicide attempts (SAs = 26) and without past suicide attempts (NSAs = 26), as well as from 22 age- and sex- matched healthy controls (HCs) during the Ultimatum Game (UG), which is a typical paradigm to investigate the responses to fair and unfair decision-making.MethodsMINI 5.0 interview and self report questionnaire were used to make mental diagnosis and suicide behavior assessment for individuals. Event-related potential (ERP) and phase-amplitude coupling (PAC) were extracted to quantify the neural activity. Furthermore, Spearman correlation and logistic regression analyses were conducted to identify the risk factors of suicidal behavior.ResultsERP analysis demonstrated that SA patients had decreased P2 amplitude and prolonged P2 latency when receiving unfair offers. Moreover, SA patients exhibited greater negative-going feedback-related negativity (FRN) to unfair offers compared to fair ones, whereas such a phenomenon was absent in NSA and HC groups. These results revealed that SA patients had a stronger fairness principle and a disregard toward the cost of punishment in social decision-making. Furthermore, theta-gamma and beta-gamma PAC were involved in decision-making, with compromised neural coordination in the frontal, central, and temporal regions in SA patients, suggesting cognitive dysfunction during social interaction. Statistically significant variables were used in logistic regression analysis. The area under receiver operating characteristic curve in the logistic regression model was 0.91 for SA/HC and 0.84 for SA/NSA.ConclusionsOur findings emphasize that suicide attempts in patients with mental disorders are associated with abnormal decision-making. P2, theta-gamma PAC, and beta-gamma PAC may be neuro-electrophysiological biomarkers associated with decision-making. These results provide neurophysiological signatures of suicidal behavior.

Sarcoidosis in Johannesburg, South Africa: A retrospective study.

Sarcoidosis is a multisystem granulomatous condition of uncertain aetiology that most frequently affects the lungs. Because of clinical and radiological similarities with tuberculosis (TB), particularly in high-prevalence regions, sarcoidosis is frequently misdiagnosed as TB. To review the clinical features of sarcoidosis patients in a South African (SA) population, adding clinical information to the relatively few studies that have been conducted in SA patients with sarcoidosis. This was a retrospective study of 102 sarcoidosis patients conducted between 2002 and 2006 at the Charlotte Maxeke Johannesburg Academic Hospital. Of 102 sarcoidosis patients, there were 69 (67.6%) females and 33 (32.4%) males. The majority (85.3%) were non-smokers. The mean age of the group was 44.6 years. One-third of patients had chronic comorbid diseases. Almost 17% had been treated initially for TB, prior to being diagnosed as having sarcoidosis. Two patients developed active TB while receiving corticosteroid treatment for sarcoidosis. The salient clinical manifestations were dry cough (the most common presenting symptom in 82.4%), dyspnoea in 53.9%, cutaneous lesions other than erythema nodosum in 33.3%, and on lung examination crackles were noted in 37.3% of patients. Raised angiotensin-converting enzyme (ACE) levels were found in 56.8% of patients. The majority (48%) of patients had stage II chest radiographic changes. Cutaneous (28.4%), mediastinal lymph node (25.5%) and transbronchial lung (25.5%) biopsies were the most frequent sites confirming granulomatous inflammation. Overall, 21.2% of patients had obstructive airway disease. Systemic corticosteroids were indicated in 87.3% of patients and the relapse rate was 60.7%. Sarcoidosis is often initially misdiagnosed as TB in SA. The most common biopsy sites for histological confirmation were the skin and mediastinal lymph nodes, and transbronchial lung biopsies were also frequently taken. Stage II chest radiographic changes were most common. Overall, systemic corticosteroids were administered in 87.3% of cases and the relapse rate was 60.7%.

An interleukin-1 polymorphism additionally intensified by atopy as prognostic factor for aseptic non-mechanical complications in metal knee and hip arthroplasty.

In contrast to infection or mechanical issues joint replacement failure following inflammatory adverse reactions is poorly understood. To assess the association of IL-1β polymorphisms and history of allergy with aseptic non-mechanical complications following arthroplasty. In 102 patients with aseptic non-mechanically caused symptomatic knee or hip arthroplasty (SA) and 93 patients with asymptomatic arthroplasty (AA) questionnaire-based history, patch test with at least standard series, lymphocyte transformation test (LTT) with nickel, cobalt and chromium and interleukin-1 polymorphism analysis were done. Three polymorphisms of the IL1B gene [IL-1b -3954 (rs1143634), IL-1b -511 (rs16944) and IL-1b -31 (rs1143627)] and one polymorphism of the IL1RN gene [IL1RN intron 2, variable number of tandem repeats, VNTR (rs2234663)] were assessed by PCR and gel electrophoresis. We found no significant difference in smoking history and atopy but 25% versus 10% of self-reported metal allergy in SA versus AA; the patch test (respective, LTT) for metal sensitivity was more often positive in SA patients. The allele 498 bp of the IL1RN polymorphism occurred significantly more often in the SA group (37% versus 11%; p < 0.0001). Upon additional presence of atopy, the difference was even greater (60% vs 10%) (p < 0.000001). There was no association of IL-1 polymorphisms with metal allergy. The IL1RN VNTR allele 498 bp was strongly associated with SA. In patients with a history of atopy, presence of the IL1RN VNTR allele 498 bp led to a four-fold higher SA prevalence compared to patients without this allele.